Perspectives on primary eye care

Perspectives on primary eye care We think of primary eye care (PEC), and any kind of primary health care (PHC), as a 'frontline' activity, providing care and identifying disease before it becomes a serious medical issue. However, as this course showed, even a cursory review of systems across the world reveals that there is no common understanding of what primary eye care means and there exists a wide variation both in its content and in the way in which it is delivered. The content of primary eye care Taking a historical perspective, one can trace the initial efforts at establishing PEC to corneal disease, particularly in children, which led to the initiation of vitamin A supplementation programmes, and to trachoma control, which emphasised hygiene and access to water. In a broad sense, primary eye care is an integral part of comprehensive eye care. It is targeted not only towards preventing blindness and visual impairment, but also towards providing services to redress ocular morbidity. The box on this page provides a list of components of PEC, but in reality its content can vary greatly, as shown by the speakers' presentations. The discussion focused particularly on the three following aspects: Timely referral It was felt that correct identification and timely referral were crucial to the success of PEC. It was stressed that an accurate diagnosis was important for both treatment and referral, as a high proportion of misdiagnosis would lead to a poorer quality of service. The discussion emphasised the need to provide PEC workers with appropriate diagnostic skills. At the very least, health workers at this level need simple rules to differentiate the serious problems from the 'trivial' ones. eye examination It was acknowledged that the scope of the basic eye examination varies from country to country, depending upon the development of health services. In some countries, it may include ophthalmoscopy, which requires training. PEC in such contexts may necessitate the involvement in service delivery of medical officers or highly skilled eye care workers. However, given the shortage of such trained personnel, this approach limits the spread of PEC and restricts its availability to contexts where such expertise is available. eye health education It was observed that eye health education was a role for PEC that did not require high-level expertise, in contrast to diagnosis and eye examination. With eye health education, gains can be achieved through awareness and use of …